Jama
(Source: JAMA)
Source: JAMA - September 18, 2018 Category: General Medicine Source Type: research

Behavioral Interventions for Weight Loss
This JAMA Patient Page describes the US Preventive Services Task Force ’s recent recommendations on behavioral interventions for weight loss to prevent obesity-related problems in adults. (Source: JAMA)
Source: JAMA - September 18, 2018 Category: General Medicine Source Type: research

Proprietaries, Pianos and Probity
A correspondent, in calling attention to one of a series of resolutions we quoted last week, comments as follows: “Had this resolution been passed by the American Medical Association and been endorsed and published byThe Journal, I am inclined to think that frenzied protests would have arisen in certain quarters about the attempt of the Association to throttle ‘independent medical journalism.’” The resolution referred to by our correspondent reads as follows: (Source: JAMA)
Source: JAMA - September 18, 2018 Category: General Medicine Source Type: research

Spring Downsizing
The lilac buds   are plumper now,unharmed  by April snows.A colony of ladybugs  feeds on honeyyou dabbed  on our antique window.Our last April here,  we inventorywhat we’ll keep,  what must go. (Source: JAMA)
Source: JAMA - September 18, 2018 Category: General Medicine Source Type: research

Incorrect Expansion of a Term and Other Clarifications
This article was corrected online. (Source: JAMA)
Source: JAMA - September 18, 2018 Category: General Medicine Source Type: research

Treatment of Chronic Hepatitis B Infection —Reply
In Reply Thee in HBeAg has been referred to as an abbreviation for “envelope” in several recent studies. Magnius and Espmark first described a new antigenic specificity in individuals positive for Australia antigen (now known as HBsAg) and proposed the designation ofe for this new specificity. Although they did not state what thee stood for, others have reported that Magnius and Espmark meant for it to be a stand-alonee. Because the earliest publications do not refer to thee antigen as standing for envelope, we conclude that it does not. The review article has been corrected online and a correction notice appea...
Source: JAMA - September 18, 2018 Category: General Medicine Source Type: research

Treatment of Chronic Hepatitis B Infection
To the Editor Dr Tang and colleagues summarized the current clinical evidence on the management of chronic hepatitis B virus (HBV) infection. I have some concerns about the review. First, it is not adequate to designate HBV e antigen (HBeAg) as HBV envelope antigen. HBeAg is not a structural component of HBV itself, but a derivative of HBV core antigen (HBcAg) that is secreted into the circulation during viral replication. The HBV envelope does not contain HBeAg. (Source: JAMA)
Source: JAMA - September 18, 2018 Category: General Medicine Source Type: research

Safety of Topical Calcineurin Inhibitors for Hailey-Hailey Disease —Reply
In Reply Mr Han raises an important point regarding the use of TCIs, which are labeled for use in atopic dermatitis, to treat HHD. The FDA issued a black box warning of a possible association between TCI use and the development of cancer (lymphoma and skin) based on case reports and animal studies, a warning not supported by the American Academy of Dermatology. Most of these animal studies demonstrated an increased risk of malignancy after administration of systemic or topical calcineurin inhibitors in doses far exceeding those used by humans. (Source: JAMA)
Source: JAMA - September 18, 2018 Category: General Medicine Source Type: research

Safety of Topical Calcineurin Inhibitors for Hailey-Hailey Disease
To the Editor Dr Haley and colleagues described a patient with Hailey-Hailey disease (HHD) in a JAMA Clinical Challenge article. The authors stated that long-term topical calcineurin inhibitors (TCIs) such as tacrolimus or pimecrolimus could be applied to control HHD because they lacked the adverse effects of topical corticosteroids. However, the US Food and Drug Administration (FDA) issued a public health advisory in 2005 about a potential cancer risk associated with the use of tacrolimus, based on animal studies and case reports in a small number of patients. Although the finding is controversial, the number of patients ...
Source: JAMA - September 18, 2018 Category: General Medicine Source Type: research

Premedication for Neonates and Nonemergency Intubation —Reply
In Reply Drs Fideler and Grasshoff raise 2 concerns regarding our trial comparing 2 premedication regimens for neonates requiring nonemergency intubation in the neonatal intensive care unit (NICU). Concerning the potential neurotoxicity of anesthetics and analgesics on the developing human brain, epidemiological data on surgical anesthesia and experimental animal data have suggested an association between surgical anesthesia and neurodevelopmental impairment, resulting in an FDA warning in 2016. However, a single, brief exposure to a general anesthetic, as used in our study, was not within the scope of the FDA warning. Ava...
Source: JAMA - September 18, 2018 Category: General Medicine Source Type: research

Premedication for Neonates and Nonemergency Intubation
To the Editor Dr Durrmeyer and colleagues investigated 173 neonates requiring nonemergent intubation in a multicenter, double-blind clinical trial, randomly assigning infants to receive atropine-propofol or atropine-atracurium-sufentanil before nasotracheal intubation. The authors reported that “the frequency of prolonged desaturation did not differ significantly [between groups]…. However, the study may have been underpowered to detect a clinically important difference.” (Source: JAMA)
Source: JAMA - September 18, 2018 Category: General Medicine Source Type: research

Early Initiation of Breastfeeding
Globally, only 2 out of 5 newborns began breastfeeding within an hour of birth in 2017, leaving an estimated 78 million newborns to wait over 1 hour to be put to the breast, according to a newreport from the United Nations Children ’s Fund (UNICEF) and the World Health Organization (WHO). (Source: JAMA)
Source: JAMA - September 18, 2018 Category: General Medicine Source Type: research

Cardiovascular Disease in India
Ischemic heart disease deaths are rising in India, particularly in rural areas and among young adults, while deaths from stroke have dropped in most parts of the country, according to a study inThe Lancet Global Health. (Source: JAMA)
Source: JAMA - September 18, 2018 Category: General Medicine Source Type: research

Armadillos Bring Risk of Leprosy
Armadillos can serve as an environmental reservoir forMycobacterium leprae, the bacterial agent that causes leprosy, and hunting, handling, or eating armadillo meat can increase the risk of infection,report an international team of researchers inPLoS Neglected Tropical Diseases. (Source: JAMA)
Source: JAMA - September 18, 2018 Category: General Medicine Source Type: research

Enabling School Success to Improve Community Health
From an innovative play space designed to teach children about concepts of engineering and mathematics to an outdoor teaching kitchen to help students learn about nutrition and to new school health services for vulnerable teens, several recenthttp://nantuckethospital.org/nch-awards-762000-to-local-nonprofits-to-address-the-islands-most-pressing-health-issues/community investments by the local hospital in Nantucket, Massachusetts, aim to help the island ’s children stay and succeed in school. And for good reason: there may be no better long-term investment in health. (Source: JAMA)
Source: JAMA - September 18, 2018 Category: General Medicine Source Type: research

Vaginal Ring Contraceptive Remains Effective for 1 Year
The first vaginal ring contraceptive that women can use for a full year has receivedFDA approval. In comparison, a contraceptive ring currently marketed in the United States has to be replaced monthly. (Source: JAMA)
Source: JAMA - September 18, 2018 Category: General Medicine Source Type: research

Generic Form of EpiPen Approved
Aiming to spur competition, lower prices, and ward off drug shortages, the FDA approved thefirst generic epinephrine autoinjector to treat life-threatening allergic reactions. The approval came 2 years afterpublic outcries concerning steep price hikes for the brand name product, EpiPen, manufactured by the global drug maker Mylan N.V. (Source: JAMA)
Source: JAMA - September 18, 2018 Category: General Medicine Source Type: research

Brain Stimulation Approved for Obsessive-Compulsive Disorder
The FDA hasexpanded the approved indications for transcranial magnetic stimulation (TMS) to include obsessive-compulsive disorder (OCD). In 2008, TMS was approved to treat major depression and in 2013 got the nod for pain from certain migraine headaches. (Source: JAMA)
Source: JAMA - September 18, 2018 Category: General Medicine Source Type: research

Scholarship Support for Veterans Enrolling in MD, JD, and MBA Programs
This study compares Veterans Administration (VA) scholarship support for veterans enrolling in degree-granting medical schools vs law or business programs at the same institutions. (Source: JAMA)
Source: JAMA - September 18, 2018 Category: General Medicine Source Type: research

Association Between Maintaining Certification in General Surgery and Loss-of-License Actions
This study uses American Board of Surgery data to assess the association between maintainence of certification in general surgery and loss-of-license actions after expiration of the initial 10-year certification among general surgeons. (Source: JAMA)
Source: JAMA - September 18, 2018 Category: General Medicine Source Type: research

On Deep Learning for Medical Image Analysis
This JAMA Guide to Statistics and Methods explains the basic concepts underlying convolutional neural networks (CNNs), a type of machine learning being used to automate the reading of medical images. (Source: JAMA)
Source: JAMA - September 18, 2018 Category: General Medicine Source Type: research

USPSTF Evidence Report: Behavioral Interventions to Prevent Adult Obesity-Related Outcomes
This systematic review to support the 2018 US Preventive Services Task Force Recommendation Statement on interventions to prevent obesity-related morbidity and mortality summarizes published evidence on the benefits and harms of behavioral and pharmacotherapy weight loss and weight loss maintenance interventions in adults. (Source: JAMA)
Source: JAMA - September 18, 2018 Category: General Medicine Source Type: research

USPSTF Recommendation: Behavioral Interventions to Prevent Adult Obesity-Related Outcomes
This 2018 Recommendation Statement from the US Preventive Services Task Force recommends that clinicians offer or refer adults with a body mass index of 30 or higher to intensive, multicomponent behavioral interventions (B recommendation). (Source: JAMA)
Source: JAMA - September 18, 2018 Category: General Medicine Source Type: research

Accuracy of [ 18 F]flortaucipir PET for Alzheimer Disease vs Other Neurodegenerative Disorders
This diagnostic accuracy study characterizes the ability of [18F]flortaucipir to discriminate Alzheimer from non-Alzheimer neurodegenerative disorders among patients at dementia clinics and research centers. (Source: JAMA)
Source: JAMA - September 18, 2018 Category: General Medicine Source Type: research

Prevalence of Burnout Among Physicians
This systematic review assesses how burnout among practicing physicians has been defined in the published medical literature and estimates its prevalence by definitions, assessment methods, and study quality. (Source: JAMA)
Source: JAMA - September 18, 2018 Category: General Medicine Source Type: research

Association of Clinical Specialty With Symptoms of Burnout and Regret Among US Resident Physicians
This survey study investigates risk factors for symptoms of burnout and career choice regret among US physicians during their second year of residency. (Source: JAMA)
Source: JAMA - September 18, 2018 Category: General Medicine Source Type: research

Weight Management in Adults With Obesity
In this issue ofJAMA, the US Preventive Services Task Force (USPSTF) presents its 2018 recommendation statement and an accompanying evidence review on weight loss interventions to prevent obesity-related morbidity and mortality in adults. In this update of the 2012 USPSTF recommendation, the major recommendation did not substantially change: clinicians should offer or refer adults with a body mass index (BMI) of 30 or higher to intensive, multicomponent behavioral interventions. The task force concluded that there is moderate certainty of moderate net benefit, with little risk of harm, and provided an evidence grade of &ld...
Source: JAMA - September 18, 2018 Category: General Medicine Source Type: research

Symptoms of Burnout Among Physicians
A patient complains of intermittent wheezing. He cannot characterize the wheezing further with regard to timing, precipitating events, or how it affects his health. A physician makes a diagnosis of asthma without further evaluation, gives the patient several recommendations regarding lifestyle modification and potential precipitants, and prescribes an inhaled long-acting β-agonist and corticosteroid. (Source: JAMA)
Source: JAMA - September 18, 2018 Category: General Medicine Source Type: research

Moments of Silence in the Intensive Care Unit
In this narrative medicine essay, an intensivist tells how he and his colleagues joined in a moment of silence to honor the ICU death of a man under their care with a do-not-resuscitate order. (Source: JAMA)
Source: JAMA - September 18, 2018 Category: General Medicine Source Type: research

Informatics, Data Science, and Artificial Intelligence
This Viewpoint discusses how advances in data science and informatics are driving a transformation of biomedical research and clinical practice toward models where data mining and artificial intelligence will underlie development of precision therapies. (Source: JAMA)
Source: JAMA - September 18, 2018 Category: General Medicine Source Type: research

Highlights for September 18, 2018
(Source: JAMA)
Source: JAMA - September 18, 2018 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - September 11, 2018 Category: General Medicine Source Type: research

Types of Hospitals in the United States
This JAMA Patient Page describes the different types of hospitals in the United States and how to assess the specific health care services that they provide. (Source: JAMA)
Source: JAMA - September 11, 2018 Category: General Medicine Source Type: research

Graduate Medical Education, 2017-2018
This Appendix presents 2017 National GME Census data detailing the numbers and types of ACGME-accredited training programs and the residents and fellows in them. (Source: JAMA)
Source: JAMA - September 11, 2018 Category: General Medicine Source Type: research

Medical Schools in the United States, 2017-2018
This Appendix presents data from the 2017-2018 Liaison Committee on Medical Education (LCME) annual questionnaire detailing information on the number of students, student demographics, curriculum content, and enrollment at US medical schools. (Source: JAMA)
Source: JAMA - September 11, 2018 Category: General Medicine Source Type: research

Biological Problems of Death
In some of the recent German reviews this topic has been discussed at some length. Death is called a definite arrest and change of life. This can only occur among multicellular beings, and is not found among unicellular organisms. These latter increase by fusion, growing to a certain stage, then dividing into two parts alike in size and structure. These organisms may be called immortal, because if protected from violent death live on indefinitely. The individuals of these unicellular species on the earth to-day are far older than mankind, and as old as life itself. (Source: JAMA)
Source: JAMA - September 11, 2018 Category: General Medicine Source Type: research

Seropositive
(Source: JAMA)
Source: JAMA - September 11, 2018 Category: General Medicine Source Type: research

Cold Agglutinins in Mycoplasma Infection —Reply
In Reply Dr Fischer and colleagues correctly recognize that sensitivity and specificity of a diagnostic test can be deceiving when considering the test characteristics. In the article on cold agglutinins and mycoplasma infection, the sensitivity, specificity, and disease prevalence were included for completeness. We agree that there are better tests for mycoplasma infection. However, the objective of the JAMA Diagnostic Test Interpretation article was not to suggest that cold agglutinin testing should be used to diagnose mycoplasma infection. Rather, our intention was to assist with the interpretation of a positive cold ag...
Source: JAMA - September 11, 2018 Category: General Medicine Source Type: research

Cold Agglutinins in Mycoplasma Infection —Reply
To the Editor Dr Stein and colleagues described a patient with community-acquired pneumonia due toMycoplasma pneumoniae infection who was found to have cold agglutinins on laboratory testing. Their statement that “the presence of cold agglutinins can be suggestive of [M pneumoniae] infection ” seems misleading in light of the test characteristics they provided. (Source: JAMA)
Source: JAMA - September 11, 2018 Category: General Medicine Source Type: research

Generational Differences in Mentoring Relationships —Reply
In Reply Drs Rogawski and Rogawski urge caution regarding generational labels, arguing that conflict stems from academic traditions and healthy mentoring relationships must be tailored to each mentor-mentee dyad. We agree. As we made clear in our article: “…these assertions do not apply to every member of a generation.” (Source: JAMA)
Source: JAMA - September 11, 2018 Category: General Medicine Source Type: research

Generational Differences in Mentoring Relationships
To the Editor The article by Waljee and colleagues on mentoring millennial physicians and researchers highlighted the importance of mentoring, but it did not provide context with regard to some underlying assumptions about generational differences, which have been a focus of intense research and social commentary. Systematic reviews of studies assessing generational differences have failed to show any meaningful differences, and these findings have led many large employers to stop applying such labels to their workforce. Media outlets such as theWall Street Journal have formally announced that they will not be using the te...
Source: JAMA - September 11, 2018 Category: General Medicine Source Type: research

Generational Differences in Mentoring Relationships
To the Editor Dr Waljee and colleagues wrote that differences in the millennial generation necessitate new ways of engaging millennial mentees in clinical and research settings. We disagree that stereotypes of millennials ’ mindset are useful in improving mentoring practices. (Source: JAMA)
Source: JAMA - September 11, 2018 Category: General Medicine Source Type: research

Antiplatelet Therapy After Coronary Artery Bypass Grafting —Reply
In Reply Drs Shah and Hesterberg raised concerns about the optimal aspirin dosage for the prevention of saphenous vein graft failure after CABG. The 2011 ACC/AHA guideline recommended 100 to 325 mg/d of aspirin after CABG to reduce vein graft failure and major adverse cardiac event (MACE) rates. The 2015 AHA scientific statement for secondary prevention after CABG also recommended 81 to 325 mg/d of aspirin and stated that it was reasonable to consider mono-antiplatelet therapy with high-dosage aspirin (325 mg/d) to prevent aspirin resistance, although the benefits were not well evaluated. On the other hand, the 2014 Europe...
Source: JAMA - September 11, 2018 Category: General Medicine Source Type: research

Antiplatelet Therapy After Coronary Artery Bypass Grafting
To the Editor The Different Antiplatelet Therapy Strategy After Coronary Artery Bypass Graft Surgery (DACAB) trial provides needed insight into the utility of dual antiplatelet therapy (DAPT) with ticagrelor as the second agent in patients undergoing CABG. The current American Heart Association and American College of Cardiology (AHA/ACC) guideline is based on limited evidence and restricted to resumption of DAPT in patients who present with acute coronary syndrome. Consequently, intersurgeon variability in DAPT use is high with a relatively low rate of DAPT use. (Source: JAMA)
Source: JAMA - September 11, 2018 Category: General Medicine Source Type: research

Antiplatelet Therapy After Coronary Artery Bypass Grafting
To the Editor Dr Zhao and colleagues concluded that among patients undergoing elective coronary artery bypass graft (CABG) surgery with saphenous vein grafting, ticagrelor plus aspirin significantly increased graft patency after 1 year vs aspirin alone. However, based on current best evidence and standards of care, the aspirin dosage (100 mg/d) used in this study for the aspirin-alone group may have been suboptimal. (Source: JAMA)
Source: JAMA - September 11, 2018 Category: General Medicine Source Type: research

Promising Results in 18-Month Analysis of Alzheimer Drug Candidate
The highest dose of BAN2401, an investigational drug for early Alzheimer disease, significantly slowed cognitive decline by 30% compared with placebo at 18 months, according todetailed results from a phase 2 randomized trial presented at the Alzheimer Association International Conference in July. (Source: JAMA)
Source: JAMA - September 11, 2018 Category: General Medicine Source Type: research

HIV Preexposure Prophylaxis “Smart Pill” in Early Testing
Last November, the US Food and Drug Administrationapproved the first “smart pill” that digitally tracks medication adherence: a sensor-equipped version of the antipsychotic drug aripiprazole, marketed as Abilify MyCite. Now, a preexposure prophylaxis (PrEP) pill for HIV prevention using the same sensor system from Proteus Digital Health is in development. (Source: JAMA)
Source: JAMA - September 11, 2018 Category: General Medicine Source Type: research

Heat-Activation Concentrates Chemotherapy in Liver Tumors
In a recent proof-of-concept, open-labelphase 1 trial, ultrasound noninvasively administered from outside the body safely triggered and enhanced delivery of a heat-sensitive chemotherapy drug to tumors. The trial involved 10 adult patients with unresectable and nonablatable primary or secondary liver tumors refractory to standard chemotherapy. (Source: JAMA)
Source: JAMA - September 11, 2018 Category: General Medicine Source Type: research

Mumps Outbreak Preparedness
A 2016 outbreak of mumps at 4 Indiana universities that eventually led to 281 cases revealed important gaps in vaccination record keeping and the need for better outbreak response plans at universities, according to aCDC report. (Source: JAMA)
Source: JAMA - September 11, 2018 Category: General Medicine Source Type: research

Gaps in HIV Testing for Black Men
Black men who have sex with men (MSM) living in the South are undertested for HIV despite being a high-risk group, according to a CDCanalysis. Additionally, the region fell short of recommended targets for timely referral to care for those diagnosed with HIV. (Source: JAMA)
Source: JAMA - September 11, 2018 Category: General Medicine Source Type: research